2017 HSC Section 2 - Practice Management

Pianosi et al

the informed consent process in pediatric otolaryngology and determine what factors may influence recall of the information discussed during surgical consultations. The primary objective of this study was to evaluate par- ental recall of surgical risks and benefits associated with common operations in pediatric otolaryngology. The sec- ondary objective was to assess for factors that may influ- ence recall. In particular, assessment was performed of whether the context of the discussion (eg, other people in the room), prior surgical history, parental education level, or treatment choice (watchful waiting or surgery) would influ- ence the rate of recall. Materials and Methods This study was part of a larger mixed-methods research project assessing shared decision making in pediatric otolar- yngology. 6 Local Institutional Review Board (IWK Health Centre) approval was obtained. Participants Participants were recruited from a tertiary-level pediatric hospital in eastern Canada. Consecutive parents were pro- spectively enrolled if they had children \ 6 years of age who were being evaluated for 1 of 4 conditions that may be treated with surgery ( Table 1 ). Exclusion criteria included inability to speak English and/or the lack of decision- making authority on behalf of the child. Clinic nurses informed eligible parents of the study in the waiting room before the consultation, and interested parents met with a research assistant who described the study in detail and obtained consent. Procedure If surgery was considered to be a treatment option, health care providers discussed the risks and benefits of the surgi- cal procedure during the consultation. After the discussion, the surgeon obtained consent for surgery, which was then followed by a short visit with the clinic nurse who covered information pertaining to preoperative details (eg, where to go for surgery, when to stop eating/drinking) and postopera- tive care (eg, pain management/analgesic use). All visits were video recorded with dual wall-mounted cameras in the consultation room (one camera captured a full room view and another captured the health care providers’ faces). Two weeks following the consultation, participants com- pleted a telephone interview with the research assistance consisting of open- and closed-ended questions regarding their recall of the information discussed during the visit. Specifically, parents were encouraged to recall all risks and benefits of the surgery discussed during the consultation. Although parents were aware that this telephone call would occur (‘‘cold calling’’ was not allowed according to the Institutional Review Board), they were not made aware of the purpose. Each interview was transcribed; transcriptions of these conversations were later checked for accuracy.

Table 1. Baseline Information of Participants.

n

%

Age of child, mo 12

8

9.5

13-24 25-36 37-48 49-60

28 20 16 12 59 12 11

33.3 23.8 19.0 14.3 70.2 14.3 13.1

Martial status Married

Common law

Single

Divorced/separated

2

2.4

Ethnicity

Caucasian

75

89.3

African Canadian Asian Canadian First Nations/Native

4 2 1 1 1

4.8 2.4 1.2 1.2 1.2

Middle Eastern

Other

Education level Completed high school or less

19 26 20 19

22.6 31.0 23.8 22.6

Community college

Undergraduate university

Graduate or postgraduate training

Conditions/surgery a Chronic/recurrent tonsillitis/ adenotonsillectomy

7

8.3

Obstructive sleep apnea/ adenotonsillectomy

31

36.9

Chronic/recurrent acute otitis media/ear tubes Chronic/recurrent nasal obstruction/ adenoidectomy

55

65.5

7

8.3

Surgical decision Surgery

49 35

58.3 41.7

Watchful waiting

a Sixteen children (19.0%) had . 1 of these conditions.

Measures

Demographic questionnaire. Relevant questions included rela- tionship to child, parent and child age, parent marital status, education level, ethnicity, household income, presence of siblings, and previous surgical history of the patient and/or sibling. Risks and benefits coding. Video recordings of the consultation visits and transcripts of the follow-up phone calls were coded for mention of the risks and benefits of surgery. Coding sheets were created for each operation based on review of the literature (see Appendix 1 at www.otojournal.org/ supplemental).

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